Dietary intake quality and associated factors in one year-old children seen by primary healthcare services

O objetivo foi analisar a qualidade do consumo alimentar de crianças com um ano de idade acompanhadas por um serviço de Atenção Primária à Saúde (APS). Trata-se de estudo transversal aninhado a uma coorte de saúde bucal infantil em que foram coletados dados de crianças nascidas em 2013 e acompanhadas por 2 anos, em Porto Alegre. Foi aplicado um questionário sobre variáveis maternas e frequência de consultas de puericultura, medidas antropométricas e consumo alimentar da criança. Para tal, foi gerado um escore a partir da pontuação criada conforme o SISVAN (Sistema de Vigilância Alimentar e Nutricional). Foi calculado um modelo multivariado, por meio da Regressão de Poisson com variância robusta. A amostra consistiu de 249 crianças. Encontrou-se 30,5% (76) de qualidade ruim/regular da alimentação, que no modelo multivariado esteve associada com nível educacional do responsável, sendo até ensino médio incompleto (RP = 2,14, IC95% = 1,03-4,44) e ensino médio completo (RP = 1,70, IC95% = 0,81-3,54), assim como não ter consultado com dentista (RP = 2,54, IC95% = 1,33-4,84) ou ter consultado até o quarto mês de idade (RP = 1,94, IC95% = 1,01-3,72). Conclui-se que não consultar com dentista no primeiro ano de vida e menor escolaridade materna repercutem negativamente na qualidade alimentar infantil.The purpose of this paper was to analyze the food intake quality in one year-old children seen by a primary healthcare (PHC) service. This is a cross-sectional studied nested within a child oral health cohort study which collected data regarding children born in 2013 and monitored in Porto Alegre for two years. We applied a questionnaire on maternal variables and frequency of pediatric appointments, weight and height measurements, and children’s food intake. To that end, a score was generated based on the points assigned according to SISVAN (meaning ‘food and nutrition monitoring system,’ run by the Brazilian Ministry of Health). A multivariate model was calculated using Poisson regression with robust variance. The sample comprised 249 children. We found 30.5% (76) of poor/regular dietary quality, which in the multivariate model was associated to the guardian’s educational background, considering up to incomplete high school (PR = 2.14, CI95% = 1.03-4.44) and complete high school (PR = 1.70, CI95% = 0.81-3.54), as well as their failure to see a dentist (PR = 2.54, CI95% = 1.33-4.84) or having seen one before the age of four months (PR = 1.94, CI95% = 1.01-3.72). It is our conclusion that failing to see a dentist within the first year of life and lower maternal schooling negatively impact on children’s dietary quality

Exploring the staphylococcus aureus in patients infected of the tertiary-care university hospital: results of the retrospective cohort study

Objective: To establish a baseline of knowledge regarding about inappropriate therapy, virulence and resistance in a cohort of patients infected with S. aureus. Methods: Retrospective cohort study in tertiary-care university hospital was employed to evaluate the risk factors and the impact of inappropriate therapy among patients with Staphylococcus aureus infections, resistance and virulence. To assess the presence of the genes was performed PCR. Results: Patients with MRSA were older and hospitalized 17 days longer than those with MSSA infection, which were in ICU with a bloodstream infection. 50.0% received inadequate antibiotic therapy and we found virulence factors associated with MRSA (mecA, LukS, fnbB and clfA genes). Conclusion: These data show that surveillance studies related to Staphylococcus aureus infections remain essential to identify resistance and inform policy on resistance

The complete genome sequence of Chromobacterium violaceum reveals remarkable and exploitable bacterial adaptability

Chromobacterium violaceum is one of millions of species of free-living microorganisms that populate the soil and water in the extant areas of tropical biodiversity around the world. Its complete genome sequence reveals (i) extensive alternative pathways for energy generation, (ii) ≈500 ORFs for transport-related proteins, (iii) complex and extensive systems for stress adaptation and motility, and (iv) wide-spread utilization of quorum sensing for control of inducible systems, all of which underpin the versatility and adaptability of the organism. The genome also contains extensive but incomplete arrays of ORFs coding for proteins associated with mammalian pathogenicity, possibly involved in the occasional but often fatal cases of human C. violaceum infection. There is, in addition, a series of previously unknown but important enzymes and secondary metabolites including paraquat-inducible proteins, drug and heavy-metal-resistance proteins, multiple chitinases, and proteins for the detoxification of xenobiotics that may have biotechnological applications

Bacteremia associadas a cateteres vasculares centrais: etiologia, patogênese e fatores de risco em uma UTI de adultos clínico-cirúrgica de um hospital universitário brasileiro

Bloodstream infection (BSI) associated and related to Central Venous Catheter (CVC) resulted in increasing rates of morbidity, mortality and hospital costs. The aim of this study was to investigate the incidence, etiopathogenesis and risk factors related to BSI associated and related to CVC, in a assorted adults Intensive Care Unit (ICU). A longitudinal study of patients using CVC, and case (patients with bacteremia) versus control (patients without infection) of adults in the ICU was carried in Hospital das Clínicas of the Federal University of the Uberlândia, from April 2007 to march 2008 by the NNIS system ( National Nosocomial Infection Surveillance ). Samples from nasal, hub, and insertion site of the catheter were made with swab and cultures on blood agar, MacConkey, Salt Mannitol and Sabouraud. The microorganisms from blood were recovered in the microbiology laboratory of the hospital and the tips of CVC, analyzed by quantitative technique. We evaluated 502 patients admitted to the ICU, of which 435 were using CVC, with 11.2% developing BSI and only tree related to catheter, with an incidence rate of primary bacteremia of 9.5 per 1000 CVC days. The incidence rate of sepsis was 21.3%, with the acquired in hospital accounting for 61.9% of the total, and the acquired in the community was 30.9%. The frequencies of total mortality of these patients were 9.3%, 40.5% and 54.5% in those patients with clinical sepsis, severe sepsis and septic shock, respectively, the majority of deaths (60.6%), during the period of investigation, related to hospital sepsis The investigation of the origin of this microorganisms causing this bacteremias, including those defined as asymptomatic infections (N=17) showed no relation with the hub and skin. The significant risk factors, by univariate analysis, for all bacteremia, including primary (N=34) and secondary (N=15) were: use CVC ≥ 15 days, parenteral nutrition, use ≥ 2 antibiotics and nasal colonization by S. aureus. The independent risk factors for the development of bacteremia included the use of ≥ 2 ATB and Parenteral Nutrition. The coagulase-negative Staphylococci was the most common microorganism causing BSI related to CVC (52.9%). The incidence of bacteremia was right (11.2%), most primary (69.0%) associated with CVC, with the coagulasenegative Staphylococci as the main casual agent.Mestre em Imunologia e Parasitologia AplicadasAs infecções de corrente sanguínea (ICS) associadas/relacionadas a Cateter Venoso Central (CVC) resultam em aumento das taxas de morbidade, mortalidade e custos hospitalares. O objetivo do trabalho foi investigar a incidência, etiopatogênese e fatores de risco de ICS associadas/relacionadas à CVC, em Unidade de Terapia Intensiva (UTI) mista de adultos. Foi realizado um estudo longitudinal de pacientes em uso de CVC, bem como caso (pacientes com bacteremia) versus controle (pacientes sem infecção) na UTI de adultos do Hospital de Clínicas da Universidade Federal de Uberlândia, no período de abril/2007 a março/2008, pelo sistema NNIS ( National Nosocomial Infection Surveillance ). Coletas de narina e pele no sitio de inserção do CVC além do canhão dos cateteres, foram realizadas com swab e cultivadas em agar sangue, MacConkey, Manitol Salgado e Sabouraud. Os microrganismos do sangue foram recuperados no laboratório de Microbiologia do hospital e as pontas de CVC, analisadas por técnica quantitativa. Foram avaliados 502 pacientes internados na UTI, dos quais 435 estavam em uso de CVC, com 11,2% desenvolvendo infecção de corrente sanguínea e apenas três relacionados ao cateter, com taxa de incidência das bacteremias primárias de 9,5/1000 CVC dias. A taxa de incidência de sepse foi de 21,3%, com as de natureza hospitalar respondendo por 69,1% do total, e as comunitárias por 30,9%. As freqüências de mortalidade total destes pacientes foram de 9,3%, 40,5% e 54,5% naqueles pacientes com sepse clínica, sepse grave e choque séptico, respectivamente, sendo a maioria dos óbitos (60,6%), durante o período de investigação, relacionados com sepse hospitalar. A investigação da origem dos microrganismos nestas bacteremias, incluindo as definidas como infecções assintomáticas (N = 17) não revelaram relação com o canhão e/ou pele. Os fatores de risco significativos, pela análise univariada, para todas as bacteremias, incluindo as primárias (34) e secundárias (15) foram: tempo de uso de CVC ≥ 15 dias, nutrição parenteral, uso de ≥ 2 ATB e colonização nasal por S. aureus. Os fatores de risco independentes para o desenvolvimento de bacteremia incluíram o uso de ≥ 2 ATB e Nutrição Parenteral. O Staphylococcus coagulase-negativo (SCoN) foi o microrganismo mais freqüente nas ICS associadas e relacionadas a CVC (52,9%). A incidência de bacteremias foi alta (11,2%), a maioria primária (69,0%) associadas ao CVC, com o SCoN como principal agente causal

Vigilância epidemiológica em UTI pediátrica e de MRSA em Hospital de Assistência Terciária do Estado de Minas Gerais

Healthcare-associated infections (HAI) represent a major cause of morbidity, mortality and costs, principally those caused by bacteria resistant and multiresistant to antibiotics. The present study evaluates the epidemiology and pathogenesis of HAI in the Pediatric Intensive Care Unit (PICU), as well as in patients with infections caused by S. aureus in a tertiary-care teaching hospital, focusing on incidence rates and epidemiological indicators, density of use of antibiotics, risk factors for development of these infections and associated mortality to Methicillin-resistant Staphylococcus aureus (MRSA). The study included National Helathycare Safety Network (NHSN) surveillance (prospective, longitudinal) of patients in PICU of Hospital de Clínicas of the Federal University of Uberlândia (HC-UFU), the samples were recovered from the microbiology laboratory of the hospital, and evaluation of risk factors was made through a case (patients with HAI) versus control (patients without infection) study, from August/2009 to August/2010. An individual form of surveillance, with epidemiological, clinical and microbiological data from patients with S. aureus infections was filed. We recovered 255 isolates of S. aureus obtained from 230 patients, identified by the microbiology laboratory of the HC-UFU, from January to December 2010. We conducted a case-control matched study to assess associated mortality rates by MRSA, considering only patients with bloodstream infection (BSI). The study was approved by the Research Ethics Committee of the University (no003/11). HAI were a significant cause of morbidity in patients in the PICU, with a rate of 26.7 nosocomial infections per 1000 patient-days. Sepsis (19.6/1000 patient-days) was the most common infection, and 44.1% of the patients with sepsis had primary sepsis, and the main source of these infection were CVC or unknown, while in the secondary sepsis, lung and urinary tract were more frequent sources (8.8% each). Univariate analysis of risk factors for HAI showed the following: use of CVC (p = 0.01), use of more than two antibiotics (p <0.001), length of stay (p <0.0001) and ASIS V score (p <0.001), the first two being independent for the development of HAIS. Among the 15 cases of bloodstream infections associated with CVC, 40.0% were related to the use of this device. The high density of antibiotic use was not related to a decrease in the incidence of HAI in the investigated period. The evaluation of S. aureus in the hospital showed that 29.8% was MRSA. The epidemiological indicators showed an infection rate of 40.5 per 1000 patientdays. Sepsis was the most common infection in the investigated period. The use of antibiotics was not related to increased incidence of nosocomial infection by MRSA/1000 patient-days. Analyzing the risk factors, only the prior use of antibiotics (p <0.001) was an independent factor for MRSA infection. The hospital mortality was significantly higher among patients who had MRSA infection. The associated mortality rate of patients with MRSA BSI was 50.0% (p = 0.0134). The rate of HAI in the pediatric ICU was high (22.0%), with the majority acquired in the unit and represented by the family of Enterobacteriaceae as main agents. Sepsis was the most common cause of HAI in both, PICU and S.aureus infections in the hospital, with significant association with invasive devices. Our data suggest that methicillin resistance may be related with increased associated mortality to the microorganism among patients who acquired nosocomial bloodstream infection by S.aureus.Doutor em Imunologia e Parasitologia AplicadasAs infecções relacionadas à assistência à saúde (IRAS) representam uma das principais causas de morbidade, mortalidade e custos, principalmente aquelas causadas por bactérias resistentes e multirresistentes aos antibióticos. O presente estudo propôs avaliar a epidemiologia e etiopatogenia das IRAS na Unidade de Terapia Intensiva Pediátrica (UTIP), assim como dos pacientes com infecções por S. aureus em hospital terciário de ensino, com foco nas taxas de incidência e indicadores epidemiológicos, densidade de uso de antibióticos, fatores de risco para desenvolvimento dessas infecções e mortalidade associada ao Staphylococcus aureus resistente à meticilina (MRSA). O estudo incluiu vigilância NHSN ( National Healthycare Safety Network ) (prospectiva, longitudinal), de pacientes internados na UTIP do Hospital de Clínicas da Universidade Federal de Uberlândia (HC-UFU), com recuperação dos isolados no laboratório do hospital, e avaliação dos fatores de risco através de estudo caso (pacientes com IRAS) versus controle (pacientes sem infecção), no período de Agosto/2009 a Agosto/2010. Uma ficha individual, com dados epidemiológicos, clínicos e microbiológicos foi preenchida para vigilância das infecções por S. aureus. Foram utilizadas 255 isolados de S .aureus obtidas de 230 pacientes, identificadas pelo laboratório de microbiologia do HC-UFU, durante o período de janeiro a dezembro de 2010. Foi realizado um estudo caso versus controle pareado para avaliar a taxa de mortalidade associada ao MRSA, considerando, apenas, os pacientes com infecção de corrente sanguínea. O trabalho foi aprovado pelo comitê de ética em pesquisa da universidade (no003/11). As IRAS foram causa significativa de morbidade intra-hospitalar nos pacientes na UTIP, com taxa de 26,7 infecções hospitalares por 1000 pacientes-dia. A sepse (19,6 por 1000 pacientes-dia) foi a infecção mais comum, e 44,1% dos pacientes com sepse apresentaram sepse primária, com o CVC como foco principal ou desconhecido, enquanto nas secundárias, o pulmão e trato urinário foram os focos mais frequentes (8,8% cada). A análise univariada dos fatores de risco para IRAS apontou os seguintes: uso do CVC (p=0,01), uso de mais de dois antibióticos (p<0,001), tempo de internação (p<0,0001) e score ASIS V (p<0,001), sendo os dois primeiros independentes para o desenvolvimento de IRAS. Dentre os 15 casos de infecções de corrente sanguínea associadas ao CVC, 40,0% foram relacionadas ao uso deste dispositivo. A elevada densidade de uso de antibióticos não foi relacionada à diminuição na incidência de IRAS no período investigado. A avaliação do S. aureus no hospital revelou que 29,8% foram MRSA. Os indicadores epidemiológicos mostraram taxa de infecção de 40,5 por 1000 pacientes-dia. A sepse foi a infecção mais comum no período investigado. O uso de antibióticos, também não foi relacionado ao aumento na incidência de infecções hospitalares por MRSA/1000 pacientes-dia. Na análise dos fatores de riscos, somente o uso prévio de antibióticos (p<0,001) foi fator independente para infecção por MRSA. A mortalidade hospitalar foi significantemente maior entre os pacientes que tiveram infecção por MRSA. A taxa de mortalidade associada no grupo de pacientes com ICS por MRSA foi de 50,0% (p=0,0134). A taxa de IRAS na UTI pediátrica foi alta (22,0%), com a maioria adquirida na unidade e representada pela família Enterobacteriaceae como agentes causais. A sepse foi a causa mais comum de IRAS, tanto na UTIP quanto por S. aureus no hospital, com significante associação com uso de dispositivos invasivos. Nossos dados sugerem que a resistência à meticilina pode ser relacionada com maior mortalidade associada ao microrganismo, entre os pacientes que adquiriram infecções hospitalares da corrente sanguínea por S. aureus

Active surveillance to determine the impact of methicillin resistance on mortality in patients with bacteremia and influences of the use of antibiotics on the development of MRSA infection

Introduction Methicillin-resistant Staphylococcus aureus (MRSA) is among the most important pathogens of nosocomial infections, mainly in intensive care units (ICUs), and accounts for 40-60% of all healthcare-associated S. aureus infections. We evaluated the incidence of nosocomial infection by S. aureus, identified the risk factors for MRSA infection, and evaluated the effect of resistance to methicillin on mortality in patients. Methods We conducted MRSA surveillance at a university hospital in Brazil from January 1, 2010, to December 31, 2010, and performed a retrospective case-control matched study to evaluate the frequency of subsequent MRSA bacteremia and death among patients. We evaluated and compared the risk factors between patients with MRSA and methicillin-sensitive Staphylococcus aureus (MSSA) infection. Results Sepsis was the most common cause of infection (17.7/1,000 patient-days), followed by surgical site (11.4/1,000 patient-days), pneumonia (4.1/1,000 patient-days), and urinary tract infection (2.4/1,000 patient-days). The significant risk factors were time of hospitalization, use of central vascular catheter (CVC), urinary catheter, nasogastric tube, parenteral nutrition, tracheostomy, mechanical ventilation, and previous antibiotic administration, the latter of which was the only independent risk factor for MRSA infection. Mortality was significantly higher in patients with MRSA. The number of antibiotics tested was not related to increases in the frequency of MRSA/1,000 patient-days. The incidence of mortality attributable to MRSA (bloodstream infection) BSI was 50%. Conclusions Surveillance results showed that the use of high levels of antibiotics was directly related to the development of MRSA infection, and the mortality attributable to MRSA in patients with bacteremia was significant

Chemotherapy-related fatigue: the perspective of women with breast câncer / Fadiga secundária à quimioterapia na perspectiva da mulher com câncer de mama

Objetivo: Descrever os fatores coadjuvantes para ocorrência da fadiga secundária à quimioterapia e os recursos do conhecimento cultural, utilizados para seu alívio. Método: Estudo prospectivo, misto, realizado com 47 mulheres com câncer de mama e fadiga, em um hospital universitário. Foram analisadas as respostas das questões abertas da Escala de Fadiga de Piper Revisada, que foram submetidas à Análise de Conteúdo. Resultados: Como causas para a fadiga foram descritas seis categorias: medo e preocupação; quimioterapia; estado emocional/psicológico; desajustes no relacionamento familiar; alteração na autoimagem; esforço físico/atividades diárias. Cinco categorias foram apontadas como recursos para alívio: buscar a Deus; banho; repouso; medidas de distração; chorar. Considerações finais:  Diante da subvalorização das queixas, relacionadas à fadiga, pelos profissionais, as mulheres passam a buscar por estratégias de alívio no conhecimento cultural. A valorização dos saberes é essencial para definição de condutas efetivas, que possibilitem melhoria da qualidade de vida e redução dos efeitos negativos da fadiga